Health Equity: 10/15/07

Monday, October 15, 2007

[EQ] Health Care Quality Indicators Project - 2006 data collection update report

Health Care Quality Indicators Project - 2006 data collection update report

Edward Kelley, Sandra Garcia Armesto, Maria Luisa Gil Lapetra, Lihan Wei and the Members of the HCQI Expert Group

OECD HEALTH WORKING PAPERS NO. 29, 2007

Organisation for Economic Co-operation and Development, Paris France

This report is an update to the OECD Health Working Paper No. 22, Health Care Quality

Available online as PDf file [165p.] at: http://www.oecd.org/dataoecd/57/22/39447928.pdf

“….This paper reports on the results of that second round of data collection. Data is presented here on an augmented indicator set considered fit for the purpose of making international comparisons on quality of health care. The data is comprised of 19 indicators (17 initial indicators plus 2 new ones). The paper also presents the data provided on 7 other indicators that are not yet considered fit for international comparison. In this round of data collection, data were reported by 32 countries…..”

“…The indicator selection criteria applied in the process of creating the original and current indicator list are summarised here. For an indicator to be a useful tool for evidence-based policy decisions, two conditions should be met. First, it has to capture an important performance aspect. Second, it must be scientifically sound.

The importance of an indicator can be further broken down into three dimensions:

• Impact on health. What is the impact on health associated with this problem? Does the measure address areas in which there is a clear gap between the actual and potential levels of health? The impact on health is quantified where data is available for each indicator by using mortality and morbidity estimates from the World Health Organization for the ‘EURO A’10 group of countries, (Murray, 2001). This group of countries includes most of the countries participating in the OECD HCQI Project.

• Policy importance. Are policymakers and consumers concerned about this area? Although this dimension is difficult to quantify objectively, the cost associated with the condition covered by each indicator is used to indicate the economic importance related to each indicator. Where suitable evidence on costs exists, it is also presented for each indicator.

• Susceptibility to being influenced by the health care system. Can the health care system meaningfully address this aspect or problem? Does the health care system have an impact on the indicator independent of confounders like patient risk? Will changes in the indicator give information about success or failure of policy changes? This dimension is discussed based on a review of the relevant literature demonstrating that the health system can influence each indicator.

The scientific soundness of each indicator can also be broken down into three dimensions:

• Face validity. Does the measure make sense logically and clinically? The face validity of each indicator in this report is based on the basic clinical rationale for the indicator and on past usage of the indicator in national or other quality reporting activities.

• Content validity. Does the measure capture meaningful aspects of the quality of care? Content validity is assessed through a literature review of studies relevant to each indicator.

• Reliability. Does the measure provide stable results across various populations and circumstances? Reliability of each indicator is assessed through a literature review of studies assessing the stability of results across populations or circumstances.

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ IKM Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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PAHO/WHO Website: http://www.paho.org/
EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

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[EQ] Unnatural Causes: Is Inequality Making Us Sick?

UNNATURAL CAUSES: IS INEQUALITY MAKINGS US SICK?

Unnatural Causes is a four-hour series that will, for the first time on television, sound the alarm about the extent of our alarming socio-economic and racial disparities in health—and search for their causes. The Unnatural Causes Web site will include multiple entry points and dynamically delivered content tailored to various user interests. PBS 2007/2008

Website: http://www.unnaturalcauses.org/site-description.html

Series Structure:

Program One: Sick of It? (wt) - 55 minutes

Why do some of us get sicker and die sooner? What are the connections between healthy bodies, healthy bank acounts and skin color? We travel to Louisville, Kentucky to discover how social policy, growing economic inequality and racism affects our health.

Program Two: Place Matters (wt) - 26 minutes

Our street address can be a powerful predictor of our health. In Richmond, California we witness how one neighborhood exposes its residents to health threats while in Seattle, Washington, another neighborhood is being created that promotes health. What public policies and community actions make the difference?

Program Three: Becoming American (wt) - 26 minutes

On average, poor immigrants of color actually arrive in the U.S. healthier than the average American. But the longer they are here, the less healthy they become. We follow Mexican immigrants laboring on the mushroom farms of Pennsylvania to find out why they are healthier, what's grinding down their health over time (and even more so, that of their children), and what they are doing to reverse this trend.

Program Four: When the Bough Breaks (wt) - 26 minutes

African American pre-term births and infant mortality rates remain more than twice the national average. The babies of African American women with professional degress face as much risk as being born early and low-birthweight than white high school drop-outs. Might the cumulative impact of racism over the life-course be the culprit?

Program Five: Bad Sugar (wt) - 26 minutes

Diabetes is a growing American epidemic and Native Americans were the first to suffer its profound effects. We travel to the O'odham Indian reservations of southern Arizona to see how history and powerlessness can drive the disease, while Native efforts to regain control of their communties' economic destiny and re-connect to their culture offer hope for the future.

Program Six: Not Just a Paycheck (wt) - 26 minutes

Unemployment and job insecurity isn’t just bad for your pocketbook – it’s bad for your health. Must it be this way? Workers in Michigan and Sweden were both thrown out of work by the same corporate giant. One town struggles against depression, spousal abuse and an uptick in heart disease and diabetes while the other seems to be doing just fine.

Program Seven: No Man Is an Island (wt) - 26 minutes
Pacific Islanders, even native Hawaiians, have poor health outcomes. In the Marshall Islands and in the unlikely spot of Springdale, Arkansas we can see how U.S. occupation, foreign policy and globalization impact peoples' health--often in unanticipated ways.

Highlights of the site content include:

§ Case Studies - loosely structured as medical investigations, case studies will provide a "guided tour" of series themes and point visitors to other areas of interest on the site. Each case study will include an emailable Sidebar that highlights success stories, action steps and related issues

§ Interactivities - educational games and activities that illustrate important concepts from the series, geared towards television viewers and the public. For example:

· A Perfect Neighborhood: what really distinguishes a healthy environment from an unhealthy one? what policy decisions contribute to this?

· YOYO Health: how does the U.S. compare to other countries in terms of health, wealth, and inequality? what are we doing differently?

· A Tale of Two Smokers: two personal stories illustrate how life circumstances constrain or promote our ability to make healthy choices

· Eye of the Beholder: an interactive poll that helps us quantify the impact of race on health

· Health Equity Quiz: test your knowledge of key health equity concepts

· Neighborhood Stress Test: how does your neighborhood affect your health and what can you do about it?

· The Game of Life Expectancy: which factors affect how long you will live? how can we all live longer?

§ Explore Health Equity – for self-directed learners, a searchable database of articles, PDFs, transcripts, fact sheets, research and video clips, including pre-populated, annotated searches on major topics

§ Action Center – comprehensive resources and information for taking action, including a calendar of events, a step-by-step toolkit for using the series, highlighted success stories, and Connect Up!, our database of health equity organizations

§ Ask the Experts – a moderated Q&A, in which site visitors pose questions for key scholars

§ Video Clips – episode and interview excerpts as well as extra material, all of which users can email to others and/or embed in their own sites

§ About the Series – episode descriptions, transcripts, credits and discussion guides

§ For Educators - lesson plans and primers on using our materials in the classroom

§ For Press - press kits, photos, backgrounders, interview links and suggested sources

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[EQ] Search for Evidence and Critical Appraisal: Health Services Research

Search for Evidence and Critical Appraisal - Health Services Research (HSR)

KCE Process notes

Carine Van de Voorde, Christian Léonard

Brussels: Belgian Health Care Knowledge Centre (KCE); 2007. KCE Process notes, 2007

Available online as PDF file [26p.] at: http://www.kce.fgov.be/Download.aspx?ID=878

“….This note describes the methodology to conduct a review of the literature on a health services research (HSR) topic. It provides a systematic approach to achieve uniformity in retrieval and quality of content. In consultation with KCE the methodology may be adapted to suit specific purposes or approaches of the literature review. This note (version June 2007) should be considered as a living document. To take account of new evidence or new methods, yearly updates are required. The next update is scheduled for June 2008.

“….Research topics in the domain of HSR are often ‘complex and multidimensional’ topics studied with different research methodologies. In this note we structure possible HSRresearch topics into four broad domains: (1) the organizational structure of the health care system, (2) the way it is financed, (3) the payment scheme of providers and services and (4) the provision of services, including the benefits package….”

TABLE OF CONTENTS

1 INTRODUCTION

2 METHODOLOGICAL APPROACH TO LITERATURE SEARCH

2.1 STEP 1 – DEVELOPMENT OF A REVIEW PROTOCOL

2.2 STEP 2 – FORMULATING THE REVIEW QUESTION(S)

2.3 STEP 3 – LOCATING STUDIES AND SOURCES OF INFORMATION

2.3.1 Electronic bibliographic databases

2.3.2 Other sources

2.3.3 Documenting a search strategy

2.4 STEP 4 – SELECTING STUDIES AND SOURCES OF INFORMATION

2.4.1 Evidence sifting

2.4.2 Study selection criteria

2.5 STEP 5 – CRITICAL APPRAISAL OF THE EVIDENCE

2.6 STEP 6 – DATA EXTRACTION

2.7 STEP 7 – ANALYSING AND INTERPRETING RESULTS

3 TEMPLATE FOR THE REPORTING OF A LITERATURE SEARCH

4 INTERNATIONAL COMPARISONS

4.1 SELECTION OF THE COUNTRIES

4.2 SELECTION OF THE VARIABLES

4.3 AWARENESS OF IMPLICIT HYPOTHESES

5 APPENDICES

APPENDIX 1

APPENDIX 2: DOCUMENTING A SEARCH STRATEGY

APPENDIX 3: FLOW DIAGRAM OF STUDY SELECTION PROCESS

APPENDIX 4: EXAMPLE OF DATA EXTRACTION FORM

6 REFERENCES AND USEFUL LINKS

6.1 REFERENCES

6.2 USEFUL LINKS

Cochrane: www.cochrane.org

CRD: http://www.york.ac.uk/inst/crd/report4.htm

QUORUM statement: http://www.consort-statement.org/QUOROM.pdf

Quality appraisal checklists

• http://www.york.ac.uk/inst/crd/report4.htm

• http://www.phru.nhs.uk/casp/critical_appraisal_tools.htm#qualitative

Sources of information

• http://www.nlm.nih.gov/nichsr/corelib/hecon.html

• http://weblogs.elearning.ubc.ca/googlescholar/greylit_manual_May11.pdf

• http://www.info.doh.gov.uk/doh/refr_web.nsf/Home

• http://www.nrr.nhs.uk/ .

• http://www.oaister.org/

• http://www.ala.org/ala/acrl/acrlpubs/crlnews/backissues2004/march04/graylit.htm

• http://www.nlm.nih.gov/archive//2060905/nichsr/ehta/chapter10.html

• http://www.nlm.nih.gov/nichsr/corelib/hecon.html

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.